Worried that you worry too much? Everyone worries or gets scared sometimes. But feeling extremely worried or afraid much of the time, or repeatedly feel panicky, may be signs of an anxiety disorder.
Anxiety disorders include panic attacks, post-traumatic stress disorder, and obsessive-compulsive disorder. They are among the most common mental illnesses, affecting roughly 40 million American adults. A person has an anxiety disorder if she or he has persistent worry for more days than not, for at least several months. Some people with anxiety feel they have always been worriers, even since childhood or adolescence. In other people, anxiety comes on suddenly, triggered by a crisis or a period of stress, such as the loss of a job, a family illness, the death of a relative, or other tragedy.
Numerous therapies can help control anxiety. These include psychotherapy and medication, ideally supported by good nutrition, sleep, and regular exercise. People who are anxious tend to reach for unhealthy "comfort" food—and then worry about it. Or they completely avoid food, skipping meals or even fasting—and worry that something is wrong, such as an undiagnosed cancer. Healthy eating can avoid these anxiety triggers.
Not getting enough sleep can boost a person's anxiety level. On the flip side, getting enough sleep can help control stress and anxiety. So can getting regular exercise—aim for 30 minutes of moderate-intensity exercise five days a week.
A child's world is full of dangers, real and imaginary, that many adults forget they ever experienced. Most childhood fears are normal, temporary, and eventually outgrown, but studies still show that anxiety disorders are among the most common childhood psychiatric conditions. In a high proportion of cases, it turns out that the symptoms of an adult anxiety disorder first appeared in childhood, so treatment of abnormal childhood anxiety is not only important for its own sake but may help prevent adult disorders.
Children's minds and emotions are constantly changing and developing, and they do not all develop at the same rate, so it is not always easy to distinguish normal fears from those that require special attention. Newborns typically fear falling and loud noises. Fear of strangers begins as early as six months and persists until the age of two or three. Preschool children usually fear being separated from their parents; they may also be afraid of large animals, dark places, masks, and supernatural creatures. Older children may worry about death in the family, failure in school, and events in the news such as wars, terrorist attacks, and kidnappings. Adolescents have sexual and social anxieties and concerns about their own and the world's future. These anxieties become a problem only if they persist and cause serious distress, destroy family harmony, or interfere with a child's development or education.
Generalized anxiety disorder. Formerly called overanxious disorder of childhood, these days generalized anxiety in children is recognized as the same disorder of uncontrolled worry that occurs in adults. Children with this disorder are self-conscious, self-doubting, and excessively concerned about meeting other people's expectations. They need constant reassurance and approval from adults. They may worry about school grades, storms, burglary, hurting themselves while playing, or the amount of gas in the tank. They often feel restless and tense and complain of headaches, stomachaches, and other physical symptoms.
In the United States, more than 2 million adults suffer from bipolar manic depressive disorder, an illness of extreme moods. It is characterized by deep depression followed by periods of hyperactivity and elation, referred to as mania, with periods of normal mood in between. Bipolar disorder often leads to substance abuse and one in four people with the condition attempt suicide.In a recent study published in the American Journal of Psychiatry, researchers set out to determine how often major childhood depression turns into bipolar disorder. The researchers followed up on 72 subjects who, at an average age of 10.3 years, had been treated for major depressive disorder with the tricyclic antidepressant drug nortriptyline. They also studied 28 normal subjects.At the time of follow-up, the average age of the subjects who had had prepubertal major depressive disorder was 20.7 years. Of these subjects, 33.3% now had bipolar disorder, compared to none of the normal comparison subjects.These results may, in part, be due to heredity. A large portion of the prepubertal children who had been diagnosed with a major depressive disorder had family histories of bipolar disorder. Because bipolar disorder tends to run in families, these children may have been more vulnerable to developing the condition. Another possibility is that the children who were originally treated with nortriptyline already had bipolar disorder, but had not yet experienced their first manic episode.Clinicians treating children with antidepressants should be aware of the risk that children with major depressive disorder may develop adult bipolar manic depressive disease.
Another study, published in Psychology and Medicine, sought to determine the long-term prognosis of women with postpartum psychiatric disorders. 50-80% of women experience some degree of postpartum depression within one month of delivering a child. Postpartum psychiatric disorders are more extreme.The study authors used standardized questionnaires to determine the long-term outcome of 64 women who had been hospitalized with postpartum psychiatric disorders 23 years earlier, and who had been interviewed for a 1982 study of women with diagnoses of schizophrenia, schizo-affective, bipolar, or unipolar affective disorders.The researchers found that 75% of the women had recurrent psychiatric illness, and 37% of the women had at least three subsequent episodes. However, only 29% of the 34 women who gave birth after the initial postpartum psychiatric disorder had additional episodes of maternal psychiatric illness. In addition, a majority of the 64 women were functioning well in society; 71-73% were employed and in stable relationships.The women with the best outcomes were those who had an initial diagnosis of unipolar disorder, those who experienced psychiatric illness after a first pregnancy, and those whose psychiatric illness started within one month of delivery.July 2001 Update